Head & Neck Cancer (Dr. Mao) Flashcards
Potential Skin and Mucosal sites for head/neck cancer
-nose cavity -paranasal sinuses -oral cavity -pharynx -larynx -thyroid glands -salivary glands
essentials of H&N cancer for PAs
-early diagnosis!!! (recognizing tumors) -pt. support -post-treatment surveillance (recognize tumor recurrence) -modifying causative patient behaviors (tumor prevention)
second most common skin cancer
squamous cell carcinoma
most common skin cancer
basal cell carcinoma
how does basal cell carcinoma spread?
spreads by local invasion (gets bigger and bigger), but does not tend to metastasize to distant sites
characteristics of BCC (how it looks)
-open sores -pearly! shiny bumps -red patch/pink growth -raised
SCC presentation (how it looks)
-tend to be ulcerated -scaly -elevated growths with central depressions
Where does malignant melanoma originate?
melanocytes
Important acronym for diagnosis of malignant melanoma
Assymetric Border irregularity Color variation/multiple Diameter >6mm Enlarging, evolving
Types/names of malignant melanoma
-superficial spreading -lentigo melanoma -acral lentiginous -nodular
staging melanoma is based on
depth of invasion -clark’s levels or Breslow’s
Risk factors of skin cancer
-sun exposure -# moles -fam hx -immunocompromised (like kaposi’s sarcoma, etc) -precancerous lesions like actinic keratosis or dysplastic nevi
Presenting signs of cancer
-non-healing ulcer -enlarging mass, neck mass -pain -hoarseness, dysphagia -anosmia, nasal obstruction, serous otitis, cranial neuropathies, otalgia
risk factors of cancer
-tobacco & alcohol -viral (HPV, EBV) -immune suppression -nutritional deficiencies -occupational exposure like woodworking -gastroesophageal reflux
How much greater is risk of H&N cancer in smokers with nonsmokers
5-35x greater in smokers
___% of patients with H&N cancer smoke tobacco
85-90%
Alcohol increases risk of cancer by how much
2-15x
_________ are synergistic carcinogens
alcohol and tobacco
Potentially premalignant lesions in the head and neck
-leukoplakia -erythroplakia -actinic keratoses of skin -squamous carcinoma in situ -dysplasia -verrucous hyperplasia
T in TNM staging system
T (0-4)
-size or characteristics of primary tumor
N in TNM staging system
N (0-3)
-size & location of cervical lymph node metastases
M in TNM staging system
M (0-1)
-distant metastases
SCC of tongue
SCC of maxillary alveolar ridge
SCC of lip
SCC of Lip
SCC floor of mouth
SCC of buccal mucosa
Leukoplakia
actinic keratosis (precancer)
Kaposi’s sarcoma
mucosal melanoma
presentation of salivary gland malignancies
- present as gradually enlarging, painless mass
- facial nerve weakness
risk factors of savilary gland malignancy
risk factors: radiation
sx/presentation of thyroid gland malignancies
- painless enlarging mass
- compressive sx
- hoarseness
risk factors for thyroid gland malignancy
- prior radiation
- fam hx
- iodine deficiency
work up for h&n cancers
thorough h&p
- fiberoptic exam of pharynx & larynx
- imaging- CT WITH contrast, U/S, PET-CT
- needle aspiration/ biopsy
- staging endoscopy anf further biopsy
treatment options for H&N cancers
- surgical excision
- radiation therapy
- chemo
- radioactive iodine
- combinations
What does neck dissection control/ why would you do neck dissection in H&N cancers?
- control lymph node metastasis
- surgical removal of lymph nodes
Reconstructive options for H&N cancer
- primary closure
- flaps
- skin grafting
- bone grafting
How is radiation therapy typically given for H&N cancer
typically given as photon (cobalt) radiation
Complications of radiation therapy for H&N cancer
- dry mouth (xerostomia), increased dental & periodontal disease), osteoradionecrosis-mandibular bone
typical treatment regimen for radiation therapy for H&N cancer
- 200cGy fractions
- once per day
- five days per week
- 6-7 weeks
Typical agents of chemotherapy for H&N cancers
-cisPlatinum, 5-Fluorouracil (5FU), methotrexate
complications of chemo for H&N cancers
-include mucositis, nausea, vomiting, hearing loss, decreased immunity
Treatment of well-differentiated thyroid cancer
- total thyroidectomy
- ablative dose of radiactive iodid (4-6 weeks later)
tx of Medullary carcinoma (thyroid cancer)
- doesn’t resond to I-131
- occasionally radiated
tx of undifferentiated carcinoma (thyroid cancer)
-carries poor prognosis regardless of tx
Notes on prognosis in H&N cancers
- generally higher stage = poorer prognosis
- 5 yrs tumor free, generally means cured for SCC
- pt’s MUST stop smoking for a chance at good prognosis
